AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. May 2000, Volume 2, Number 5.

Ethics Poll

Should Doctors Fudge on Insurance Forms to Help Patients?

The Ethics Poll is a snapshot of the opinions of interested readers.

A recent study published in JAMA revealed that nearly 40% of physicians reported having manipulated reimbursement rules to obtain health care for their patients. Certain kinds of "gaming" seem plainly indefensible, such as when, for instance, a physician manipulates rules solely for his or her economic benefit or to merely satisfy patient preferences. For example, a patient may desire a cosmetic rhinoplasty, which is not covered by a health plan, and a physician could code the procedure as a correction for a deviated septum, which is covered. However, other situations may involve decisions whereby a patient could suffer serious harm if she does not receive a medical treatment that is not covered by her health plan. Faced with such a dilemma, a physician may be strongly tempted to bend the rules either to avoid serious harm or to provide an important benefit to the patient. Do you think manipulation of reimbursement rules is ethical in these situations?

Poll results reflect the opinions of visitors to the site who voluntarily answer the poll questions. Those visitors do not represent a random sample of Virtual Mentor readers. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.